Dirk Mueller MD, Presenter: Nothing to Disclose

Maria Isbary MS, Abstract Co-Author: Nothing to Disclose

Holger Frank Boehm MD, Abstract Co-Author: Nothing to Disclose

Jan Stefan Bauer MD, Abstract Co-Author: Nothing to Disclose

Ernst Josef Rummeny MD, Abstract Co-Author: Nothing to Disclose

Thomas Marc Link MD, Abstract Co-Author: Nothing to Disclose

Vertebral fractures are the most common complication of osteoporosis but remain often undetected as they may occur without clinical symptoms. Moreover they are frequently missed by radiologists on routine lateral chest radiographs. As these fractures lead to important health consequences such as disability and increased mortality and further fractures are preventable by appropriate medication recognition is important. The purpose of this study was to investigate how frequently vertebral fractures were found in lateral chest radiographs, how frequently they were missed in the initial reports and to assess treatment for osteoporosis in the postmenopausal women with fractures.

782 consecutive routine lateral chest radiographs of postmenopausal women (age ≥ 50 years) were evaluated. The radiographs were chosen without knowledge of clinical findings and were independently reviewed by two radiologists. A validated semi-quantitative method (spinal fracture index = SFI) was used to assess the radiographs for vertebral fracture. A clinically relevant vertebral fracture was defined as a deformity with a height reduction of a vertebra of more than 25% (> grade I). In addition medical record notes and radiology reports were assessed to determine how many fractures were correctly identified and how frequently osteoporosis specific treatment was initiated.

The mean age of the postmenopausal women was 69.3 years (SD ± 10.0 years). Clinically relevant vertebral fractures were found in 110 patients (14.1 %). Only 34/110 (30.9 %) of those fractures were noted in the official radiology reports and in only 21/110 (19.1 %) treatment with antiresorptive agents or estrogen replacement with calcium and vitamin D was initiated.

Only one third of osteoporosis-related vertebral fractures were recorded in the official radiology report and in less than 20% of the postmenopausal women adequate treatment was initiated by the clinicians. As future osteoporotic fractures can be prevented by appropriate medication and chest radiography has the potential to serve as a tool to diagnose osteoporosis it is of utmost importance for the radiologist to focus on the spine in these radiographs.

Mueller, D, Isbary, M, Boehm, H, Bauer, J, Rummeny, E, Link, T, Recognition of Osteoporosis-related Vertebral Fractures on Chest Radiographs in Postmenopausal Women.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4409148.html